radiotherapy for adults with brain tumours...hair loss usually starts around 3 weeks after treatment...
TRANSCRIPT
Radiotherapy for adults with brain tumours
When you’re diagnosed with a brain tumour, radiotherapy is one type of treatment you may have.
Radiotherapy, or radiation treatment, uses controlled doses of invisible, high energy beams of charged particles.
These are targeted at the tumour to destroy the tumour cells, while causing as little damage as possible to surrounding healthy cells.
Radiotherapy may be used where surgery isn’t possible, or after surgery to kill any remaining cells. It can also be used to prevent a tumour from returning or slow down the growth of the tumour.
Please see other fact sheets for information about specialist types of radiotherapy - Proton Beam Therapy (PBT) and Stereotactic Radiotherapy (SRT).
In this fact sheet: What happens
if I’m given
radiotherapy?
What are the
side-effects of
radiotherapy?
Answers to other
questions you
may have about
radiotherapy to
the brain
© The Brain Tumour Charity 2017. Registered Charity no 1150054 (England and Wales) SC045081 (Scotland)
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What happens if I’m given radiotherapy?
Before you’re given radiotherapy treatment, a lot of planning and
preparation is needed. This is to make sure the treatment is as
effective as possible whilst minimising the side-effects.
Before radiotherapy treatment
Planning
Your radiotherapy treatment is very carefully planned by a team of
medical specialists to make sure it reaches and destroys as many
tumour cells as possible, while avoiding as much healthy tissue
as possible.
The team will consist of specialists, always including a clinical
oncologist (specialising in radiotherapy), a radiographer (trained in
using x-ray equipment) and a medical physicist (who you would not
usually meet, but who specialises in radiation).
First, you’ll have a radiotherapy planning scan. This is usually a CT
(Computerised Tomography) scan, but sometimes is an MRI
(Magnetic Resonance Imaging) scan .
For more information, see the Scans for adults with brain tumours
webpage and fact sheet.
The scan creates a 3D image of your tumour, showing its shape and
location within the brain. Together, the image and measurements
from the scan help your medical team make precise plans about
where to target the radiotherapy.
Sometimes an additional imaging machine, called a simulator, is used
either to plan simple brain treatments or to check the complex
treatment planned from the CT scan.
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All efforts will be made to avoid more critical areas of the brain. These
areas include the brain stem (responsible for functions such as
breathing and heart rate); the optic nerve (which helps you see); and
the cochlear in the ear (to reduce long-term hearing loss).
Sometimes it’s impossible to avoid more critical areas of the brain
without compromising treatment.
So depending on your tumour and its location, you may need to be
given radiotherapy which includes one or more of these areas.
As well as helping to plan the area to be targeted, the scan also helps
the medical physicist plan the doses of radiation and how the
treatment should be ‘staged’.
This means how many sessions of radiotherapy will be needed and
how much radiation needs to be given at each treatment session. This
is important as it makes sure the normal cells have time to recover
before the next dose of radiation.
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Treatment mask
It’s important to lie very still during treatment, so that the
radiotherapy is directed at the right part of the brain.
To help you stay still, you’ll have a treatment mask designed and made
especially for you to wear each time you have treatment.
It’s made specifically to fit your head and fixes to the treatment couch
to hold your head in the same position and place each time you have
radiotherapy.
How the mask is made:
Your mask may either be made in the ‘mould room’ or the room
where you have your planning CT scan at the hospital.
It will take about 30 minutes to make the mask, though you should
allow more time for the whole process.
Different hospitals use different materials to create the mask.
This may mean having a Plaster of Paris impression taken of your
face to make a Perspex mask.
More commonly, centres use a thermoplastic material to make the
mask. This is a plastic that goes soft and mouldable in warm water.
The thermoplastic mesh is warmed in water to make it soft.
The mesh is then smoothed onto your face, so that the final mask
is an exact replica of the size and shape of your head.
It will feel warm as it sets and has sometimes been described as a
bit like having a warm flannel pressed onto your face.
Gaps will be made for your eyes, nose and mouth, so you’re always
able to breathe easily.
The mask only needs to be worn during the planning and when you
have radiotherapy. You don’t need to wear it at other times.
To see a video of how a radiotherapy mask is made, see the Cancer
Research UK video: bit.ly/radiotherapy-mask
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Radiotherapy mask
being made
Images reproduced with the
kind permission of Cambridge
University Hospitals NHS
Foundation Trust
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Once the mask is made:
Your radiographer (a specialist in giving radiotherapy) will make
ink marks on the mask. These are used to help position you more
easily each time you have radiotherapy treatment and will make
the process smoother.
If you’re having craniospinal (whole brain and spine) radiotherapy,
you may also have some very small markings put on your skin to
line up the rest of your body.
During radiotherapy treatment Your treatment is planned to suit your individual needs, so may be
very different to the treatment of other people you may meet.
During treatment:
You’ll lie on the radiotherapy bed with the radiotherapy machine
above you.
Medical staff will take some time positioning you to make sure the
radiotherapy goes to the correct place.
During the positioning, the radiographer will place your mask over
your head and attach it to the table to prevent you from moving.
This will stay on for the duration of the individual treatment, which
is called a fraction.
Before the radiotherapy machine is switched on, the medical staff
will leave the room.
This is to prevent giving any radiation to people who don’t need it.
The medical staff will be nearby though and easily able to hear, see
and speak to you. You’ll also be able to hear and speak to them.
There are a number of different types of radiotherapy machine.
Some may move around you during treatment, while others look
more like a CT scanner. (See the Scans for adults fact sheet.)
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Hospitals will often allow you to take a CD along, so you can listen
to your music while you’re having radiotherapy.
Once the treatment is finished, the medical staff will come back
into the room. They’ll detach the mask from the radiotherapy table
and remove it, so you can sit up and get off the table.
The medical staff will keep your mask until the next treatment
session.
How long will treatment take?
Treatment times will vary, depending on your individual treatment
plan.
Each session of radiotherapy (fraction) generally lasts only a few
minutes, though it can be as short as a few seconds.
Your appointment as a whole will take considerably longer, due to the
medical staff spending time positioning you to make sure you’re in the
right place.
If you’re having radiotherapy to the brain and spine (known as
craniospinal radiotherapy), it can take a bit longer.
An example of a typical radiotherapy plan is treatment once a day,
Monday to Friday, with a break at the weekends.
The period of time over which your radiotherapy is spread will also
depend on your treatment plan, but it’s common for it to last for
around 4 to 6 weeks. Simple treatments are usually much shorter - a
few days to 2 weeks.
Before the treatment begins, your medical team will be able to tell
you how many sessions you’ll need, how often and over what period.
They’ll also be able to give you a guideline for how long each visit to
the hospital should take.
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After radiotherapy treatment Generally radiotherapy is given as an outpatient, so you’ll be able to
go home after each session. Occasionally, if you feel unwell, you may
have to stay in hospital overnight. If you’re in hospital having another
treatment, such as chemotherapy, you can go back to your ward.
Once the whole course of treatment is complete, you can take your
treatment mask home, if you want to.
Some people use them to hang their earrings, headphones or hats on.
They can help friends and family understand the treatment you’ve
gone through.
Following treatment, you’ll have regular check-up appointments to
monitor the effects of the radiotherapy on your tumour and any
side-effects you may get.
You’re likely to experience some side-effects. Some of these will be
temporary and gradually clear once the treatment has finished.
Others may be long-term.
What are the typical immediate side-effects of radiotherapy? Radiotherapy works because it does the greatest damage to rapidly
dividing cells, such as tumour cells. However, it can also affect any
normal cells within the treatment area, particularly those which also
divide rapidly.
Rapidly dividing cells include skin cells, cells lining the mouth and the
digestive tract, plus blood cells in the bone marrow. These areas,
therefore, tend to have the most common side-effects.
You may find it helpful to ask your doctor about the side-effects you
might experience.
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Generally, the more immediate side-effects will gradually disappear
within around 6-12 weeks after treatment finishes.
Common side-effects of radiotherapy include:
Tiredness
You’re very likely to feel tired during your treatment and, as the
weeks of radiotherapy go on, this tiredness could increase.
This may be because your body is using its resources to repair any
damage to healthy cells caused by the radiotherapy, or because of all
the journeys to and from the hospital.
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Unfortunately, the feeling of tiredness doesn’t go away immediately
once the treatment stops and could continue for a number of weeks.
Let yourself rest or nap when you need to and don’t feel you must
fight the tiredness. Try to plan rest breaks into your days even if
you’re not feeling tired.
Health teams now encourage all patients to do at least 30 minutes
gentle exercise every day to minimise radiotherapy-induced fatigue.
This could be a gentle walk.
For more information, including practical tips on coping with
fatigue, see the Fatigue webpage and fact sheet.
Hair loss
Unfortunately, you will lose some hair during radiotherapy, and this
can be quite distressing for you.
Generally, your hair will only be lost from the places where the
radiotherapy beam enters and leaves your head. If, however, you have
whole brain radiotherapy, you’re likely to lose hair from your whole
head. You can talk to your radiographer about where you’re most
likely to lose hair.
Knowing that there’ll be some hair loss means that you can plan
ahead.
Take a picture of how you usually wear your hair, so that a hairdresser
can shape a wig. You could also keep a lock of your hair to match the
colour and texture.
Some people have found gradually cutting their hair shorter, or even
shaving it all off, before the start of treatment can help it feel less of a
shock.
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Hair loss usually starts around 3 weeks after treatment starts. Most
hair loss is temporary, and will begin to grow again 2-3 months after
finishing treatment.
Re-growth is often not as thick as it was before, and your hair may not
be the same colour or texture. For example, it may be curly, when it
was straight before. For some people, hair loss can be permanent.
There are many styles of wig that you can choose from, including
synthetic (monofibre) and human hair wigs. And also lots of places
that sell hats, bandanas or wigs and hairpieces as practical
suggestions for coping with hair loss.
See the Resources section later in this fact sheet for details.
Skin sensitivity
During or a few weeks after radiotherapy, some people develop
changes to their skin in the area being treated, i.e. on your scalp.
These can be like sunburn (red, blotchy and itching) in people with
pale skin, and darkening of the skin in those who have darker skin.
As your skin will be more sensitive after radiotherapy, you should
take care to protect it from strong winds and the sun. Always wear
suntan lotion and a sunhat with neck protection when you’re outside.
Usually, the sensitivity will fade in the month or so after treatment,
but you should keep using high factor sunscreen long-term on the
areas of the skin that have had radiotherapy.
This is because radiotherapy can permanently destroy the pigment-
producing cells in your skin. These cells enable you to tan and protect
you from sunlight damage and developing skin cancer.
Your health team will be able to give you further guidance if you
develop skin sensitivity.
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Feeling sick (nauseous)
If you have radiotherapy to the lower part of your brain, you may feel
sick or actually be sick following treatment.
This can start from around an hour after treatment and last some
weeks. Your doctor can give you anti-sickness tablets to manage this.
Reduced appetite
Feeling sick and tired can make some people temporarily lose their
appetite during radiotherapy. This can lead to weight loss.
You may find it easier to eat several smaller snacks throughout the
day, rather than three ‘regular’ meals. Or ask your health team if they
can refer you to a dietitian.
For more information, see the Diet webpage and fact sheet.
Myelosuppression
(slowing of the production of blood cells by the bone marrow)
Radiotherapy can temporarily slow the production of blood cells by
the bone marrow.
Low blood cell counts are usually not severe enough to cause major
problems. When there is a break from treatment for a few days, blood
cell counts usually recover.
However, the low levels can sometimes lead to anaemia, increased
risk of infection and/or bleeding, such as bruising or nosebleeds.
If you’ve had radiotherapy to the brain and spine, or if you’re also
having chemotherapy, you’re more at risk of these effects.
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Worsening of symptoms
Radiotherapy to the brain can cause swelling in the treatment area.
This swelling increases the pressure in the head, so can sometimes
make symptoms worse before they get better.
Your doctor might give you steroids to try to prevent this. Your
symptoms usually get better in time.
See the Steroids for adults with brain tumours webpage and fact
sheet for more information.
Your health team will discuss possible side-effects with you before
you have treatment. Feel free to ask them any questions at any time if
you have concerns.
Will there be any long-term side-effects of radiotherapy? Once the whole course of treatment is complete, you’ll have regular
check-up appointments to monitor the effects of your radiotherapy
treatment. Generally, side-effects, apart from hair loss, will gradually
disappear within around 6-12 weeks.
It’s important to know that radiotherapy is given in a way designed
to limit the chance of permanent side-effects as much as possible.
Very few people develop long-term difficulties.
Occasionally, some side-effects can be longer-term or develop later in
life. Your health team will talk through any side-effects with you
before any treatment is given.
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Long-term effects of radiotherapy could include impacts on:
Cognitive skills
Cognitive skills include thinking, memory, learning, concentration,
decision-making and planning. They also include processing skills,
such as recognising and making sense of information from your
senses, particularly sight and hearing.
If a large part or the whole of your brain is treated, there is a long-
term risk of cognitive impairment.
For further information, see the Cognition and brain tumours
webpage and fact sheet.
Vision
If the radiotherapy is delivered near to your eyes, there’s a chance
of developing a cataract in the lens of the eye several months or
even years later. Cataracts can make your vision cloudy, blurred
or dim. However, they can usually be easily treated with a simple,
small operation.
Hormonal effects
Radiotherapy treatment that includes the pituitary gland at the base
of the brain can affect the production of the various hormones that
the pituitary controls.
This can cause a variety of symptoms related to functions such as
body temperature, growth, salt and water balance, sleep, weight
and appetite.
As part of your follow-up after radiotherapy, you may have blood
tests to check your hormone levels, but if you notice any new
symptoms, you should discuss them with your doctor.
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Second tumour
Radiotherapy can cause changes that, over a long period, can lead to a
second tumour developing.
However, the benefits of having radiotherapy far outweigh the risks,
and only a small number of people will develop a second cancer
because of the treatment they’ve had.
Long-term side-effects can take months and sometimes years to develop.
Other frequently asked questions
Will the treatment be painful?
No, you can’t see or feel the radiotherapy beams and you won’t feel
any heat from it either.
You’ll hear the machine though, which can be quite noisy.
The Brain Tumour Charity animation about radiotherapy for children
includes a sample of the noise. thebraintumourcharity.org/jake
Will I be radioactive after my treatment?
No. The radiation comes from the machine and does not stay inside
your body. You don’t need to take special precautions when you leave
the hospital. It’s safe to be around others, including children.
Will I need to give up work?
It’s likely that you’ll need to take some time off work during treatment
and for at least a little while afterwards.
Precisely when you go back to work must be your decision. It’s
important that you don’t feel pressurised to go back too soon and
that you do what feels right for you.
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Some people find it helpful to return to work as soon as possible, as it
gives them something else to focus on. For others, it’s months before
they feel ready.
Your health team may be able to signpost you to organisations that
can help you return to work, or contact The Brain Tumour Charity for
information.
For more information, see the Employment resources webpages and
downloadable resources.
Why is the treatment given in several small doses instead of one
large dose?
The full dose of radiation you need will be carefully calculated,
depending partly on the size, type and location of the tumour.
The dosage is then divided into a number of smaller doses called
fractions. There are two main reasons for this.
The first is that the sensitivity of a cell to radiation depends on where
it is in its growth cycle.
Giving radiotherapy in several doses means that the tumour cells will
receive radiation when they’re in their most sensitive stage.
The second reason is to allow healthy cells to recover between
treatments.
Cells that grow and divide quickly (tumour cells) are much more
sensitive to radiation than non-dividing, resting (normal) cells. Having
a gap between doses gives the normal cells time to recover while still
causing damage to the tumour cells.
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Resources
Wigs and other headwear
There are many different styles of wig to choose from, including
synthetic (monofibre) and human hair wigs. You can also buy
headscarves and other headwear.
You can get free synthetic wigs on the NHS if:
you live in Scotland, Wales or Northern Ireland
(via free prescriptions)
you live in England and:
you're under 16, or under 19 and in full-time education
you're a hospital inpatient
your weekly income is low
you apply to the NHS Low Income Scheme and receive an HC2
certificate for full help with health costs
you have a valid NHS tax exemption certificate
you're a war pensioner, the wig is for your accepted
disablement and you have a valid war pension exemption
certificate.
People in England who are receiving treatment for cancer, the effects
of cancer, or the effects of current or previous cancer treatment now
get free prescriptions. This includes a prescription for a synthetic wig.
Disclaimer: The Brain Tumour Charity provides the details of other organisations
for information only. Inclusion in this fact sheet does not constitute a
recommendation or endorsement. The following list is not exhaustive.
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Afrostyling
This is an online retailer selling wigs, extensions and other hairpieces.
afrostyling.com or 0161 870 2387
Annabandana
Selection of headwear that can be ordered online or by phone.
annabandana.co.uk or 01297 553747
Bohemia Fashions
Headwear for men, women and children with hair loss, including sleep
caps and padded headscarves.
bohemiaheadwear.co.uk or 01582 750083
Chemotherapy Headwear
Sells hats and headscarves for people experiencing hair loss.
chemotherapyheadwear.com or 01483 901403
Direct Wigs
Online seller of both men and women’s wigs, hair pieces and scarves.
directwigs.co.uk or 01793 632152
Hairware
Large selection of wigs, hats and other accessories. Approved by NHS
for prescription wigs.
hairware.com or 0845 713017
My New Hair
Charity that provides support and advice for medical hair loss, plus
a network of salons providing wig styling.
mynewhair.org
Little Princess Trust
Provides free real-hair wigs to young adults (male and female) up to
the age of 24, who have lost their own hair through cancer treatment.
littleprincesses.org.uk or 01432 760060
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Hero by LPT
Part of the Little Princess Trust, this service was set up in response
to some boys not being comfortable receiving a wig from a charity
called Little Princess Trust. It provides free real hair wigs to boys and
young men up to the age of 24, who have lost their hair through
treatment for cancer.
herobylpt.org.uk or 01432 760060
Hair4U
Offers free real hair wigs and a salon styling experience for young
people aged 13-24 (male and female) nationwide. Set up by Teenage
Cancer Trust.
teenagecancertrust.org/about-us/what-we-do/hair4u
or 0207 612 0370
WigBank
A network of wig banks around the UK that offer new and donated
wigs for sale. People donate wigs they no longer need. The wigs are
washed, disinfected, conditioned and sold from £20, with £5 going to
a cancer charity of the buyers choice.
wigbank.com or 0131 336 5100
Wig-Wham
Provides a personal service for women to try on wigs in her private
studio. Can offer evening and weekend appointments.
wig-wham.co.uk or 01785 823531
The Institute of Trichologists
Gives information about hair grafts.
trichologists.org.uk or 0845 604 4657
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Support Team in the following ways:
Disclaimer: This resource contains information and general advice. It should not be used as a substitute for personalised advice from a qualified specialist professional. We strive to make sure that the content is accurate and up-to-date, but information can change over time. Patients must seek advice from their medical teams before beginning or refraining from taking any medication or treatment. The Brain Tumour Charity does not accept any liability to any person arising from the use of this resource.
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© The Brain Tumour Charity.
Version 5.0 May 2018
Review date: May 2021